Radiology Environmental Impact: What Is Known and How Can We Improve?

Assessment of the role of experience in shaping sustainability perceptions within radiography

INTRODUCTION

Perceptions of environmental sustainability among radiographers can potentially be influenced by individual experiences and educational backgrounds. This study aims to investigate the perceptions and practices of radiographers regarding sustainability initiatives, emphasizing the significance of understanding their diverse experiences and backgrounds.

METHODS

This was an online survey involving 104 radiographers from various regions worldwide to evaluate their training related to global warming, their perceptions of sustainability, current practices, and the barriers they face in implementing sustainability practices.

RESULTS

Participants' knowledge regarding sustainability was significantly influenced by their social networks, including friends and family (χ2 = 12.505, p = 0.004). Notable correlations were observed between years' of experience and the belief in pollution's contribution to climate change (χ2 = 8.096,p = 0.038), as well as the perception of human activities as the primary cause of climate change (χ2 = 22.68,p = 0.011). Furthermore, involvement in environmental protection initiatives (χ2 = 19.268, p = 0.033) and the perception of local climate impacts (χ2 = 22.478, p = 0.012) were positively correlated with experience. In the field of radiography, the adoption of energy-efficient practices (χ2 = 10.482, p = 0.011) and the recycling of imaging waste (χ2 = 25.778, p = 0.004) were significantly associated with levels of experience. Lastly, the barrier identified as "Lack of Authority to make change" also exhibited a significant relationship with years of experience (χ2 = 9.449, p = 0.022).

CONCLUSION

This study indicates that staff experiences play a significant factor influencing sustainability engagement among radiographers. Barriers identified include financial constraints, insufficient leadership, safety concerns, and inadequate training.

IMPACT ON PRACTICE

The current study highlights the essential requirement for customized strategies based on radiographers' experiences to improve sustainable practices in radiography. It acknowledges the impact of organizational barriers and suggests that progress toward a more sustainable future can be achieved through individual empowerment and collaboration within the healthcare sector.

Beyond Do No Harm: Introduction to Green Radiology

ABSTRACT

In 2021, the Human Rights Council declared that having a clean, healthy, and sustainable environment is a human right. According to the WHO, 24% of deaths are attributable to environmental health risks and are largely preventable. Current predictions show that rising emissions will be linked to an enormous healthcare burden, especially for high-risk populations and historically disadvantaged communities. The US healthcare industry accounts for nearly 18% of its GDP and is a major consumer of resources. The largest healthcare-related source of greenhouse gas emissions is from the supply chain, including pharmaceuticals, other chemicals, food, and the transportation required to mobilize them accounting for 80% of emissions, with only 20% of emissions from purchased energy and the facilities directly. As a field, radiology has historically monitored its impact in terms of radiation exposure and thermal effects but has not focused on other pollutants, greenhouse gas emissions, or waste. Although tackling large issues such as climate change and pollution seems daunting, we can start by raising awareness through education, investigation, and advocacy. In this review, we discuss a systems-based approach to addressing climate change from the federal to the local level focusing on the potential role of the radiologist.

The Carbon Footprint of Hospital Services and Care Pathways: A State-of-the-Science Review

BACKGROUND

Climate change is the 21st century's biggest global health threat, endangering health care systems worldwide. Health care systems, and hospital care in particular, are also major contributors to greenhouse gas emissions.

OBJECTIVES

This study used a systematic search and screening process to review the carbon footprint of hospital services and care pathways, exploring key contributing factors and outlining the rationale for chosen services and care pathways in the studies.

METHODS

This state-of-the-science review searched the MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), GreenFILE (EBSCOhost), Web of Science, Scopus, and the HealthcareLCA databases for literature published between 1 January 2000 and 1 January 2024. Gray literature was considered up to 1 January 2024. Inclusion criteria comprised original research reporting on the carbon footprint of hospital services or care pathways. Quality of evidence was assessed according to the guidelines for critical review of product life cycle assessment (LCA). PROSPERO registration number: CRD42023398527.

RESULTS

Of 5,415 records, 76 studies were included, encompassing 151 hospital services and care pathways across multiple medical specialties. Reported carbon footprints varied widely, from 0.01 kg carbon dioxide (CO 2 ) equivalents (kgCO 2 e ) for an hour of intravenously administered anesthesia to 10,200 kgCO 2 e for a year of hemodialysis treatment. Travel, facilities, and consumables were key contributors to carbon footprints, whereas waste disposal had a smaller contribution. Relative importance of carbon hotspots differed per service, pathway, medical specialty, and setting. Studies employed diverse methodologies, including different LCA techniques, functional units, and system boundaries. A quarter of the studies lacked sufficient quality.

DISCUSSION

Hospital services and care pathways have a large climate impact. Quantifying the carbon footprint and identifying hotspots enables targeted and prioritized mitigation efforts. Even for similar services, the carbon footprint varies considerably between settings, underscoring the necessity of localized studies. The emerging field of health care sustainability research faces substantial methodological heterogeneity, compromising the validity and reproducibility of study results. This review informs future carbon footprint studies by highlighting understudied areas in hospital care and providing guidance for selecting specific services and pathways. https://doi.org/10.1289/EHP14754.

Linking theory and practice to advance sustainable healthcare: the development of maturity model version 1.0

BACKGROUND

Climate change and increased awareness of planetary health have made reducing ecological footprints a priority for healthcare organizations. However, improving healthcare's environmental impact remains difficult. Numerous researchers argue these difficulties are caused by healthcare's environmental impact being multidimensional, influenced throughout the healthcare chain, and often has downstream consequences that are hard to identify or to measure. Even though existing research describes many successful approaches to reduce healthcare's environmental impact, a robust multidimensional framework to assess this impact is lacking. This research aims at developing a maturity model for sustainable healthcare that could be used for self-assessment by healthcare professionals to identify improvement actions and for sharing best practices in environmental sustainability.

METHODS

A design-oriented approach for maturity model development was combined with an expert panel and six case studies to develop, refine and expand the maturity model for environmentally sustainable healthcare.

RESULTS

A maturity model was developed containing four domains: 'Governance', 'Organization Structures', 'Processes', and 'Outcomes and Control'. Applying the model in real-world environments demonstrated the model's understandability, ease of use, usefulness, practicality and ability to identify improvement actions for environmental sustainability in healthcare organizations.

CONCLUSIONS

This study found that healthcare practitioners could apply the maturity model developed and tested in this study in several hours without training to help them gain valuable insights into the environment footprint of the healthcare setting they worked in. Systematically implementing the model developed in this study could help address the urgent need to mitigate the substantial environmental impact of healthcare. These implementations can help evaluate and improve the maturity model.

Assessing Environmental Sustainability in Dual-Energy CT: Exploring Energy Consumption and Ecological-Economic Impact in Low Utilization Times

RATIONALE AND OBJECTIVES

Within global sustainable resource management efforts, reducing healthcare energy consumption is of public concern. This study aims to analyze the energy consumption of three Dual-Energy computed tomography (DECT) scanners and to predict the power consumption based on scan acquisition parameters.

MATERIALS AND METHODS

This study consisted of two parts assessing three DECT scanners: one Dual-Source and two Single-Source DECT. In Part A, the energy consumption for various single- and DECT scans with different acquisition parameters using a chest phantom was measured. The measurements were compared to the calculated power consumption. In Part B, the energy consumption baselines during nonutilization states of the DECT devices: idle (ready to scan), low-power (incomplete shutdown), and system-off mode (complete shutdown) were measured. Descriptive statistics were used.

RESULTS

The phantom study revealed a positive correlation between measured and calculated energy consumption (r2 =0.82), except for single-source split-filter DECT acquisitions, indicating a relationship between scan parameters and energy consumption. The baseline study results showed a mean energy consumption of 2.6kWh/hour ± 1.34kWh in idle, 0.89kWh/hour ± 0.42kWh in low-power, and < 0.01kWh/hour ± 0.003kWh in the system-off state. The potential total annual CO2 savings for the assessed DECT scanners amounted to 3767kg CO2 (low power) and 5868kg CO2 (system off) compared to the idle state. Time-related calculations indicated energy savings starting after 5 min in low-power- and after 2 min in the system-off state. Therefore, switching off the scanner, even during shorter periods of non-utilization, can be efficient.

CONCLUSION

Our results emphasize a positive correlation between scan parameters and energy consumption in DECT. Complete shutdown of DECT devices can have a significant ecological-economic impact.

Environmental Life Cycle Assessment of a U.S. Hospital-based Radiology Practice

Background Climate change, driven primarily by human-induced greenhouse gas (GHG) emissions, poses major risks to human health. Health care contributes 8.5% of GHG emissions in the United States. Purpose To estimate the life cycle environmental impact of diagnostic radiology services within a single academic medical center. Materials and Methods This process-based life cycle assessment (LCA) of a diagnostic radiology department serving adult inpatient, outpatient, and emergency department patients in a U.S. hospital followed International Organization for Standardization (ISO 14040:2006) guidelines. System components included production and distribution of imaging equipment; energy use of imaging equipment, including MRI, CT, radiography and fluoroscopy, and US; production and use of other capital equipment; production of single-use, semidurable, and durable supplies and linens; and production and energy use from onsite data storage. Meters monitored the power usage of selected imaging equipment during April 2023. Modeling assumed an equipment lifespan of 10 years. Results are reported in kilotons of CO2 equivalent (kt CO2e) emissions per scan and over a 10-year period. A sensitivity analysis assessed variability of data. Results Over a decade, these radiology services generated 4.6 kt CO2e GHG emissions, with MRI responsible for 48% (2.2 of 4.6 kt CO2e) and CT responsible for 24% (1.1 of 4.6 kt CO2e) of cumulative emissions. Clinical use of imaging equipment (all modalities) accounted for 54% of departmental GHGs (2.5 of 4.6 kt CO2e). Other notable contributions include the production of imaging equipment (11%, 0.49 of 4.6 kt CO2e), the production and use of picture archiving and communication system workstations (11%, 0.48 of 4.6 kt CO2e), and linens production and laundering (10%, 0.47 of 4.6 kt CO2e). Conclusion Energy consumption from clinical use of imaging equipment accounted for more than 50% of departmental GHG emissions, with MRI and CT equipment as the major emitters. Other notable GHG contributors include the production of imaging equipment, the production and use of picture archiving and communication system workstations, and linens production and laundering. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Thrall in this issue.

A semi-automatic analytical methodology for characterizing the energy consumption of MRI systems using load duration curves

BACKGROUND AND PURPOSE

Magnetic resonance imaging (MRI) scanners are a major contributor to greenhouse gas emissions from the healthcare sector, and efforts to improve energy efficiency and reduce energy consumption rely on quantification of the characteristics of energy consumption. The purpose of this work was to develop a semi-automatic analytical methodology for the characterization of the energy consumption of MRI systems using only the load duration curve (LDC). LDCs are a fundamental tool used across various fields to analyze and understand the behavior of loads over time.

METHODS

An electric current transformer sensor and data logger were installed on two 3T MRI scanners from two vendors, termed M1 (outpatient scanner) and M2 (inpatient/emergency scanner). Data was collected for 1 month (7/11/2023 to 8/11/2023). Active power was calculated, assuming a balanced three-phase system, using the average current measured across all three phases, a 480 V reference voltage for both machines, and vendor-provided power factors. An LDC was constructed for each system by sorting the active power values in descending order and computing the cumulative time (in units of percentage) for each data point. The first derivative of the LDC was then computed (LDC'), smoothed by convolution with a window function (sLDC'), and used to detect transitions between different system modes including (in descending power levels): scan, prepared-to-scan, idle, low-power, and off. The final, segmented LDC was used to measure time (% total time), total energy (kWh), and mean power (kW) for each system mode on both scanners. The method was validated by comparing mean power values, computed using the segmented 1-month LDC, for each nonproductive system mode (i.e., prepared-to-scan, idle, lower-power, and off) against power levels measured after a deliberate system shutdown was performed for each scanner (1 day worth of data).

RESULTS

The validation revealed differences in mean power values <1.4% for all nonproductive modes and both scanners. In the scan system mode, the mean power values ranged from 29.8 to 37.2 kW and the total energy consumed for 1 month ranged from 11 106 to 14 466 kWh depending on the scanner. Over the course of 1 month, the portion of time the scanners were in nonproductive modes ranged from 76% to 80% across scanners and the nonproductive energy consumption ranged from 8010 to 6722 kWh depending on the scanner. The M1 (outpatient) scanner consumed 99.9 and 183.9 kWh/day in idle mode for weekdays and weekends, respectively, because the scanner spent 23% more time proportionally in idle mode on the weekends.

CONCLUSIONS

A semi-automatic method for quantifying energy consumption characteristics of MRI scanners was introduced and validated. This method is relatively simple to implement as it requires only power data from the scanners and avoids the technical challenges associated with extracting and processing scanner log files. The methodology enables quantitative evaluation of the power, time, and energy characteristics of MRI scanners in scan and nonproductive system modes, providing baseline data and the capability of identifying potential opportunities for enhancing the energy efficiency of MRI scanners.

Reducing energy consumption in musculoskeletal MRI using shorter scan protocols, optimized magnet cooling patterns, and deep learning sequences

OBJECTIVES

The unprecedented surge in energy costs in Europe, coupled with the significant energy consumption of MRI scanners in radiology departments, necessitates exploring strategies to optimize energy usage without compromising efficiency or image quality. This study investigates MR energy consumption and identifies strategies for improving energy efficiency, focusing on musculoskeletal MRI. We assess the potential savings achievable through (1) optimizing protocols, (2) incorporating deep learning (DL) accelerated acquisitions, and (3) optimizing the cooling system.

MATERIALS AND METHODS

Energy consumption measurements were performed on two MRI scanners (1.5-T Aera, 1.5-T Sola) in practices in Munich, Germany, between December 2022 and March 2023. Three levels of energy reduction measures were implemented and compared to the baseline. Wilcoxon signed-rank test with Bonferroni correction was conducted to evaluate the impact of sequence scan times and energy consumption.

RESULTS

Our findings showed significant energy savings by optimizing protocol settings and implementing DL technologies. Across all body regions, the average reduction in energy consumption was 72% with DL and 31% with economic protocols, accompanied by time reductions of 71% (DL) and 18% (economic protocols) compared to baseline. Optimizing the cooling system during the non-scanning time showed a 30% lower energy consumption.

CONCLUSION

Implementing energy-saving strategies, including economic protocols, DL accelerated sequences, and optimized magnet cooling, can significantly reduce energy consumption in MRI scanners. Radiology departments and practices should consider adopting these strategies to improve energy efficiency and reduce costs.

CLINICAL RELEVANCE STATEMENT

MRI scanner energy consumption can be substantially reduced by incorporating protocol optimization, DL accelerated acquisition, and optimized magnetic cooling into daily practice, thereby cutting costs and environmental impact.

KEY POINTS

Optimization of protocol settings reduced energy consumption by 31% and imaging time by 18%. DL technologies led to a 72% reduction in energy consumption of and a 71% reduction in time, compared to the standard MRI protocol. During non-scanning times, activating Eco power mode (EPM) resulted in a 30% reduction in energy consumption, saving 4881 € ($5287) per scanner annually.

Sustainability in radiography: Knowledge, practices, and barriers among radiographers in Zimbabwe and Zambia

INTRODUCTION

As the global demand for radiography services increases, departments need to be aware of the environmental impact of their practices and strive to reduce their carbon footprint. However, sustainability in radiography, particularly in low-resource settings, remains underexplored. This study aimed to investigate the knowledge, practices, and barriers to sustainability in radiography practice among radiographers in Zimbabwe and Zambia.

METHODS

A quantitative cross-sectional study involving 216 consecutively sampled radiographers who completed an online questionnaire was conducted. Data analysis was performed using descriptive statistics, the Chi-square test, and exploratory factor analysis using principal component analysis.

RESULTS

Overall, 81.49 % of the radiographers had some familiarity with the concept of sustainability. The radiography educational curriculum was singled out as lacking sufficient content on sustainability (44.44 %). More than half of the radiographers reported the absence of deliberate sustainable practices in place in their respective departments (Zambia 51.02 %, Zimbabwe 54.69 %). The top reported barriers to sustainability include; a lack of priority for sustainability from leadership and organization (73.61 %), a lack of incentives for sustainability (75.46 %), and a lack of partnerships between suppliers and consumers on ways to improve diagnosis, patient safety and sustainability (82.4 %).

CONCLUSION

This study offers valuable insights into the current state of sustainability in radiography in Zambia and Zimbabwe, highlighting the need for academic reforms, intentional departmental practices, and systemic changes to drive sustainable efforts in the field. Future research should aim to enhance the sustainability of radiographic examinations and procedures, thereby advancing the core practice of radiographers.

Iodinated contrast media waste management in hospitals in central Norway

INTRODUCTION

The demand for iodine has increased in the last years, among other factors due to increased medical use. There is no consensus regarding iodinated contrast media (ICM)'s damaging impact on the environment and therefore the producers encourage collecting and recycling ICM waste. The aim of the study was to investigate the ICM waste management in hospitals in Central Norway and to explore the radiographers' attitudes regarding ICM recycling and possible causes of suboptimal waste management.

METHODS

The link to the electronic survey was sent to all radiographers working with computed tomography within the Central Norway Regional Health Authority. Descriptive and inferential statistics were performed.

RESULTS

Results reported from 100 radiographers from eight hospitals show that ICM leftovers are recycled or reused in most cases (26% collect them for recycling and 38% use them for oral administration) while 25% send them to the pharmacy together with other pharmaceutical waste and 8% discard them in the sink or the garbage bin. 25% reported that they are not familiar with their department's procedures related to ICM waste. 84% were concerned about the consequences of ICM waste for the environment.

CONCLUSION

There were considerable differences in the management of ICM waste amongst the hospitals and also internally within the hospitals. Improper practices, likely caused by lack of disposal plans and/or suboptimal information flow, were reported to a low extent.

IMPLICATIONS FOR PRACTICE

Local ICM waste management guidelines which are easily available for radiographers may increase both reuse and recycle rates. Including ICM waste management in the educational curriculum for radiographers can provide early understanding of the rationale behind the procedures and their environmental impact.

Sustainability in radiography education: A case study of a tertiary institution in Zimbabwe

INTRODUCTION

To equip radiographers to tackle the negative impacts of climate change, it is crucial to offer in-depth education on planetary health and sustainability. This study aimed to use a tertiary institution in Zimbabwe as a case study to assess radiography students' views on the integration of sustainability into their curriculum.

METHODS

A quantitative cross-sectional study using a questionnaire took place at a tertiary institution in Harare, Zimbabwe, where students were sampled consecutively. Categorical variables were described using frequencies and percentages. Data analysis was carried out using Stata 13.1.

RESULTS

A total of 96 out of 111 students participated, with an 86% response rate. The majority of students believed in the importance of environmentally friendly radiography practices (90.62%) and felt that sustainability is crucial for better patient care. While sustainability teaching was acknowledged in the curriculum, many students were not confident about the topic in exams. There was no consensus on the preferred methods of teaching sustainability. University lecturers specializing in climate-related fields were seen as the most suitable teachers for sustainability education.

CONCLUSIONS

The curriculum reflects efforts in sustainability education, but student confidence and awareness of climate-focused research units require improvement. Continuous education is crucial to link sustainability awareness with practical implications in radiography. Future studies should investigate tailored teaching methods to engage students effectively in sustainable radiography practices.

IMPLICATIONS FOR PRACTICE

The findings highlight the importance of ongoing education and awareness campaigns to address the disconnect between understanding the importance of sustainability and implementing it effectively in radiography practice.

Green radiography: Exploring perceptions, practices, and barriers to sustainability

INTRODUCTION

Previous research has delved into the attitudes and behaviors of diverse professions regarding environmental sustainability. However, there needs to be more research specifically targeting radiographers. This study aims to survey radiographers' perceptions, practices, and barriers to change concerning environmental sustainability in radiology.

METHODS

Institutional ethical approval was obtained (IRB-COHS-FAC-110-2024) and data collection was conducted using Google Forms (Google Inc., Mountain View, CA). The survey targeted 104 practicing radiographers across several countries. Questions were structured around five domains to gather insights into demographics, training in global warming and climate change, perceptions of sustainability and climate change, sustainability barriers, and current radiology practices on sustainability. Data analysis utilized descriptive and d inferential statistics.

RESULTS

One hundred and four radiographers completed the study. Females had a significantly higher attendance rate in environmental protection campaigns (P = 0.01). The majority of respondents (68%) believe in climate change's knowledge and impact on the natural world. Our survey findings demonstrate that 74% of respondents believe there's a need to improve sustainability practices. The most commonly used strategies to decrease energy consumption and emissions were low-energy lighting (60%), real-time power monitoring tools (41%), and energy-efficient heating systems (32%). A significant concern regarding sustainability emerges among respondents: time (50%) and lack of leadership (48%) are prevalent concerns among the identified barriers.

CONCLUSION

Participants are recognising the importance of environmental sustainability in radiology, but lack of leadership, support, authority, and facility limitations hinder their adoption.

IMPACT ON PRACTICE

Radiology must prioritize environmental sustainability by providing resources and training for radiographers and collaborating with healthcare professionals, policymakers, and environmental experts to develop comprehensive strategies for a sustainable healthcare system.

Promoting sustainability activities in clinical radiography practice and education in resource-limited countries: A discussion paper

OBJECTIVE

Urgent global action is required to combat climate change, with radiographers poised to play a significant role in reducing healthcare's environmental impact. This paper explores radiography-related activities and factors in resource-limited departments contributing to the carbon footprint and proposes strategies for mitigation. The rationale is to discuss the literature regarding these contributing factors and to raise awareness about how to promote sustainability activities in clinical radiography practice and education in resource-limited countries.

KEY FINDINGS

The radiography-related activities and factors contributing to the carbon footprint in resource-limited countries include the use of old equipment and energy inefficiency, insufficient clean energy to power equipment, long-distance commuting for radiological examinations, high film usage and waste, inadequate training and research on sustainable practices, as well as limited policies to drive support for sustainability. Addressing these issues requires a multifaceted approach. Firstly, financial assistance and partnerships are needed to adopt eco-friendly technologies and clean energy sources to power equipment, thus tackling issues related to old equipment and energy inefficiency. Transitioning to digital radiography can mitigate the environmental impact of high film usage and waste, while collaboration between governments, healthcare organisations, and international stakeholders can improve access to radiological services, reducing long-distance commuting. Additionally, promoting education programmes and research efforts in sustainability will empower radiographers with the knowledge to practice sustainably, complemented by clear policies such as green imaging practices to guide and incentivise the adoption of sustainable practices. These integrated solutions can significantly reduce the carbon footprint of radiography activities in resource-limited settings while enhancing healthcare delivery.

CONCLUSION

Radiography-related activities and factors in resource-limited departments contributing to the carbon footprint are multifaceted but can be addressed through concerted efforts.

IMPLICATIONS FOR PRACTICE

Addressing the challenges posed by old equipment, energy inefficiency, high film usage, and inadequate training through collaborative efforts and robust policy implementation is essential for promoting sustainable radiography practices in resource-limited countries. Radiographers in these countries need to be aware of these factors contributing to the carbon footprint and begin to work with the relevant stakeholders to mitigate them. Furthermore, there is a need for them to engage in education programmes and research efforts in sustainability to empower them with the right knowledge and understanding to practice sustainably.

Approaches to reduce medical imaging departments' environmental impact: A scoping review

INTRODUCTION

Global warming stands as a paramount public health issue of our time, and it is fundamental to explore approaches to green medical imaging departments/(MID). This study aims to map the existing actions in the literature that promote sustainable development in MID towards the promotion of environmental impact reduction.

METHODS

Following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), this literature search was conducted on MEDLINE, Embase and CINAHL to encompass studies published after 2013. Combinations of keywords and relevant terms related to environmental sustainability, recycling, medical waste, and greening radiology were applied for this review. Three independent reviewers screened abstracts, titles, and eligible full-text. Disagreement was solved through consensus.

RESULTS

38 out of 4630 articles met all inclusion criteria, and four additional articles were identified and added through reference search. A third of the studies included were published after 2022, and most were conducted in developed countries (36/41). Articles focused on computed tomography (9/41), magnetic resonance imaging (6/41), interventional radiology (4/41), conventional radiography (4/41), ultrasound (2/41), mixed modalities (10/41), or not applicable to an imaging modality (6/41). Four principal categories were identified to decrease ecological footprint: energy consumption, waste management, justification and environmental pollution.

CONCLUSION

To minimise the environmental impact of MIDs raising awareness and promoting education is fundamental. Examinations must be justified adequately, energy consumption must be reduced, and waste management practices need to be implemented. Further studies are required to prioritise the most effective strategies, supporting decision-making among stakeholders.

IMPLICATIONS FOR PRACTICE

Several strategies are already possible to implement to reduce the environmental impact of MIDs and improve the healthcare outcomes for patients.

Green radiology: How to develop sustainable radiology

The phenomenon of global warming due to the increased emission of greenhouse gases makes it necessary to raise public awareness about the importance of promoting sustainable practices. The field of radiology is not an exception, as it consumes a large amount of energy and resources to operate equipment and generate images. Green radiology is a sustainable, innovative, and responsible approach in radiology practice that focuses on minimizing the negative environmental effects of the technologies and procedures used in radiology. Its primary goal is to reduce the carbon, water and ecological footprint in our services based on four strategic pillars: decreasing energy, water, and helium usage; properly recycling and/or disposing of waste and residues (including contrast media); minimizing the environmental impact of ionizing radiation; and promoting eco-friendly radiology practices.

Go Green in Neuroradiology: towards reducing the environmental impact of its practice

Raising public awareness about the relevance of supporting sustainable practices is required owing to the phenomena of global warming caused by the rising production of greenhouse gases. The healthcare sector generates a relevant proportion of the total carbon emissions in developed countries, and radiology is estimated to be a major contributor to this carbon footprint. Neuroradiology markedly contributes to this negative environmental effect, as this radiological subspecialty generates a high proportion of diagnostic and interventional imaging procedures, the majority of them requiring high energy-intensive equipment. Therefore, neuroradiologists and neuroradiological departments are especially responsible for implementing decisions and initiatives able to reduce the unfavourable environmental effects of their activities, by focusing on four strategic pillars-reducing energy, water, and helium use; properly recycling and/or disposing of waste and residues (including contrast media); encouraging environmentally friendly behaviour; and reducing the effects of ionizing radiation on the environment. The purpose of this article is to alert neuroradiologists about their environmental responsibilities and to analyse the most productive strategic axes, goals, and lines of action that contribute to reducing the environmental impact associated with their professional activities.

Waste analysis and energy use estimation during MR-HIFU treatment: first steps towards calculating total environmental impact

OBJECTIVES

To assess the environmental impact of the non-invasive Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MR-HIFU) treatment of uterine fibroids, we aimed to perform a full Life Cycle Assessment (LCA). However, as a full LCA was not feasible at this time, we evaluated the CO2 (carbon dioxide) emission from the MRI scanner, MR-HIFU device, and the medication used, and analyzed solid waste produced during treatment.

METHODS

Our functional unit was one uterine fibroid MR-HIFU treatment. The moment the patient entered the day care-unit until she left, defined our boundaries of investigation. We retrospectively collected data from 25 treatments to assess the CO2 emission based on the energy used by the MRI scanner and MR-HIFU device and the amount and type of medication administered. Solid waste was prospectively collected from five treatments.

RESULTS

During an MR-HIFU treatment, the MRI scanner and MR-HIFU device produced 33.2 ± 8.7 kg of CO2 emission and medication administered 0.13 ± 0.04 kg. A uterine fibroid MR-HIFU treatment produced 1.2 kg (range 1.1-1.4) of solid waste.

CONCLUSIONS

Environmental impact should ideally be analyzed for all (new) medical treatments. By assessing part of the CO2 emission and solid waste produced, we have taken the first steps towards analyzing the total environmental impact of the MR-HIFU treatment of uterine fibroids. These data can contribute to future studies comparing the results of MR-HIFU LCAs with LCAs of other uterine fibroid therapies.

CRITICAL RELEVANCE STATEMENT

In addition to (cost-) effectiveness, the environmental impact of new treatments should be assessed. We took the first steps towards analyzing the total environmental impact of uterine fibroid MR-HIFU.

KEY POINTS

• Life Cycle Assessments (LCAs) should be performed for all (new) medical treatments. • We took the first steps towards analyzing the environmental impact of uterine fibroid MR-HIFU. • Energy used by the MRI scanner and MR-HIFU device corresponded to 33.2 ± 8.7 kg of CO2 emission.

The environmental impact of energy consumption and carbon emissions in radiology departments: a systematic review

OBJECTIVES

Energy consumption and carbon emissions from medical equipment like CT/MRI scanners and workstations contribute to the environmental impact of healthcare facilities. The aim of this systematic review was to identify all strategies to reduce energy use and carbon emissions in radiology.

METHODS

In June 2023, a systematic review (Medline/Embase/Web of Science) was performed to search original articles on environmental sustainability in radiology. The extracted data include environmental sustainability topics (e.g., energy consumption, carbon footprint) and radiological devices involved. Sustainable actions and environmental impact in radiology settings were analyzed. Study quality was assessed using the QualSyst tool.

RESULTS

From 918 retrieved articles, 16 met the inclusion criteria. Among them, main topics were energy consumption (10/16, 62.5%), life-cycle assessment (4/16, 25.0%), and carbon footprint (2/16, 12.5%). Eleven studies reported that 40-91% of the energy consumed by radiological devices can be defined as "nonproductive" (devices "on" but not working). Turning-off devices during idle periods 9/16 (56.2%) and implementing workflow informatic tools (2/16, 12.5%) were the sustainable actions identified. Energy-saving strategies were reported in 8/16 articles (50%), estimating annual savings of thousand kilowatt-hours (14,180-171,000 kWh). Cost-savings were identified in 7/16 (43.7%) articles, ranging from US $9,225 to 14,328 per device. Study quality was over or equal the 80% of high-quality level in 14/16 (87.5%) articles.

CONCLUSION

Energy consumption and environmental sustainability in radiology received attention in literature. Sustainable actions include turning-off radiological devices during idle periods, favoring the most energy-efficient imaging devices, and educating radiological staff on energy-saving practices, without compromising service quality.

RELEVANCE STATEMENT

A non-negligible number of articles - mainly coming from North America and Europe - highlighted the need for energy-saving strategies, attention to equipment life-cycle assessment, and carbon footprint reduction in radiology, with a potential for cost-saving outcome.

KEY POINTS

• Energy consumption and environmental sustainability in radiology received attention in the literature (16 articles published from 2010 to 2023). • A substantial portion (40-91%) of the energy consumed by radiological devices was classified as "non-productive" (devices "on" but not working). • Sustainable action such as shutting down devices during idle periods was identified, with potential annual energy savings ranging from 14,180 to 171,000 kWh.

Sustainable health care: a real-world appraisal of a modern imaging department

RATIONALE AND OBJECTIVES

There is universal interest in increasing sustainability in health care, including in imaging. We studied and characterized energy consumption in a representative imaging department in Denmark to identify and quantify the effect of specific optimizations.

METHODS

Protocols and energy parameters for the three main scanner modalities along with supportive systems and workflows were monitored and scrutinized. Potential savings were measured and/or calculated.

RESULTS

Only few optimizations were identified at the protocol level. However, examination of usage patterns and cooling systems revealed numerous potential optimizations which fell into three categories. 1) Optimizations requiring minimal changes in installations or workflows, for example, reduction of bed-position time, 2) optimizations requiring altered work flows such as strict adherence to timed shut-down procedures and 3) optimizations requiring retro-fitting equipment, typically at considerable monetary expense, for example fitting variable flow control on pumps. The single biggest identified optimization was raising the temperature of the circulating cooling water.

CONCLUSION

This study highlights the complexity of increasing sustainability in health care, specifically in imaging. We identified multiple potential optimizations but also technical, monetary and organizational barriers preventing immediate implementation.

Low Contrast Volume Protocol in Routine Chest CT Amid the Global Contrast Shortage: A Single Institution Experience

OBJECTIVE

To assess the effectiveness of low contrast volume (LCV) chest CT performed with multiple contrast agents on multivendor CT with varying scanning techniques.

METHODS

The study included 361 patients (65 ± 15 years; M: F 173:188) who underwent LCV chest CT on one of the six 64-256 detector-row CT scanners using single-energy (SECT) or dual-energy (DECT) modes. All patients were scanned with either a fixed-LCV (LCVf, n = 103) or weight-based LCV (LCVw, n = 258) protocol. Two thoracic radiologists independently assessed all LCV CT and patients' prior standard contrast volume (SCV, n = 263) chest CT for optimality of contrast enhancement in thoracic vasculature, cardiac chambers, and in pleuro-parenchymal and mediastinal abnormalities. CT attenuations were recorded in the main pulmonary trunk, ascending, and descending thoracic aorta. To assess the interobserver agreement, pulmonary arterial enhancement was divided into two groups: optimal or suboptimal.

RESULTS

There was no significant difference among patients' BMI (p = 0.883) in the three groups. DECT had a significantly higher aortic arterial enhancement (250 ± 99HU vs 228 ± 76 HU for SECT, p < 0.001). Optimal enhancement was present in 558 of 624 chest CT (89.4%), whereas 66 of 624 chest CT with suboptimal enhancement was noted in 48 of 258 LCVw (18.6%) and 14 of 103 LCVf (13.6%). Most patients with suboptimal enhancement with LCVw injection protocol were overweight/obese (30/48; 62.5%), (p < 0.001).

CONCLUSION

LCV chest CT can be performed across complex multivendor, multicontrast media, multiscanner, and multiprotocol CT practices. However, LCV chest CT examinations can result in suboptimal contrast enhancement in patients with larger body habitus.

Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice

INTRODUCTION

Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research.

METHODS

A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings.

RESULTS

A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel.

CONCLUSIONS

Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare.

IMPLICATIONS FOR PRACTICE

Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.